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Dear colleagues,

The HIV epidemic remains one of the world’s largest health problems. Major efforts have been made to address the epidemic. The massive antiretroviral treatment (ART) scale-up has transformed HIV into a manageable, chronic condition, changing HIV care from terminal care to chronic disease management. Large-scale roll-out of ART is, however, putting an immense burden on health systems world-wide, which are often already facing severe human resource shortages. As a response to these human resource shortages, innovative means of delivering long-term care for people living with HIV (PLWH) have been developed, such as “task shifting”. Despite the success of the ART programmes, and task shifting, among other initiatives, many countries are still faced with both prevention and treatment challenges, highlighting the need to develop new sustainable responses to successfully bring an end to the HIV epidemic. To tackle the remaining challenges, future endeavours need to focus on the search for additional human resources. A source of such support is the PLWH’s household, and this needs to be accessed. Building health-enabling households with the capacity to actively stimulate a lifestyle that fosters health offers a potential strategy to tackle the prevention and treatment challenges with which we are still faced today.

Papers addressing the potential of PLWH’s household to provide a sustainable answer to HIV prevention and treatment challenges are invited for this Special Issue and, in particular, those that include intervention and implementation activities.

Dr. Caroline Masquillier
Guest Editor

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Keywords

households
HIV
interventions
public health
HIV competent households
ART adherence
prevention
community health workers
community-based support
HIV-related stigma

Published Papers (2 papers)

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Research

14 pages, 319 KiB

Open AccessArticle

Examining Barriers to Medication Adherence and Retention in Care among Women Living with HIV in the Face of Homelessness and Unstable Housing

by Sofia B. Fernandez, Cindy Lopez, Cynthia Ibarra, Diana M. Sheehan, Robert A. Ladner and Mary Jo Trepka

Int. J. Environ. Res. Public Health 2022, 19(18), 11484; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191811484 - 13 Sep 2022

Cited by 8 | Viewed by 1847

Abstract

Despite advances in biomedical treatments, women living with HIV (WLH) who experience homelessness and housing instability suffer suboptimal HIV outcomes, even when linked to treatment. The purpose of this study was to explore experiences of housing instability among WLH and to understand its role in their ability to adhere to antiretroviral medication and remain retained in care. Sixteen women who were linked to Ryan White Program HIV care in South Florida participated in in-depth interviews. The findings focus around four larger themes: difficulty storing medication, privacy- and stigma-related issues, inconsistent access to medication and health care disruptions, and competing and unmet physical and mental health needs. Findings underscore the importance of strategies that are responsive to the disruption of routines and are sensitive to privacy issues in shared dwelling spaces; the proactive inquiry of behavioral and environmental considerations when prescribing antiretroviral medication; and the identification and treatment of comorbid conditions. This study provides evidence for strategies to facilitate self-management and improve modifiable system realities to augment larger-level policy and funding shifts that are critically needed to end the epidemic among vulnerable populations living with HIV. Full article

(This article belongs to the Special Issue Households in HIV Care and Support)

16 pages, 374 KiB

Open AccessArticle

Social Support for Improved ART Adherence and Retention in Care among Older People Living with HIV in Urban South Africa: A Complex Balance between Disclosure and Stigma

by Lucia Knight and Enid Schatz

Int. J. Environ. Res. Public Health 2022, 19(18), 11473; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191811473 - 12 Sep 2022

Cited by 9 | Viewed by 1968

Abstract

The number of older people living with HIV (OPLWH) (aged 50-plus) in South Africa is increasing as people age with HIV or are newly infected. OPLWH are potentially vulnerable because of the intersection of age-related and HIV stigmas, co-morbidities, and lack of social support. Evidence from younger populations suggests that social support can improve ART adherence and retention in care. Further, HIV status disclosure plays a role in mediating social support and may reduce stigma by facilitating access to social support. This paper draws on qualitative research with OPLWH to explore the complex associations between disclosure, social support, and HIV stigma among OPLWH in urban Western Cape. The findings demonstrate that OPLWH receive most of their support from their family and this support can facilitate adherence to ART and retention in care. However, social support is facilitated by participants’ disclosure, thus, when perceived stigma limits disclosure, social support is less accessible. Gender, age, and pre-existing vulnerability also affect disclosure to and support from kin and community. Given that social support, particularly from family members, amplifies HIV care access and ART adherence, encouraging disclosure stimulating household HIV competency is likely to both address anticipated stigma and support improved OPLWH’s health outcomes. Full article

(This article belongs to the Special Issue Households in HIV Care and Support)

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